Consent codes and laws are meant to protect both healthcare providers and care receivers. Consent on the provider side prevents misunderstandings and lapses in communication, thereby ensuring legal and ethical practices; on the receiver side, it builds trust in the provider and ensures respect for autonomy.
Shifting away from the old practices of consent, the emergence of new types of consent as a legal requirement reflects the evolution in complexity of medical treatments, social norms towards patient autonomy, and the advancement of medical technology.
Consent nowadays presupposes competence in decision-making and includes the crucial elements of disclosure, understanding, and voluntariness. With continuous refining and expansion in the scope of consent being introduced, let’s explore its varied types and how to strike a balance between patient autonomy and the provider’s responsibility for each.
Informed consent acts as the cornerstone of the patient-provider relationship. Informed consent empowers patients with the right to make informed decisions about their medical care and to make voluntary decisions about their participation in research.
It ensures that patients are well informed about the risks, benefits, and complications of the proposed intervention and have admitted to their comprehension of the information provided. The acknowledgment demonstrates the patient’s agreement to carry on with the recommended procedure voluntarily.
Under US jurisdiction, the concept of informed consent is enshrined under both federal and state laws.
Federal laws and regulations include:
Some state laws across the US that require obtaining informed consent include:
Note: This is not an exhaustive list.
When consent is not expressly granted by patients but rather assumptions are drawn from a person’s actions and circumstances in a particular situation, such cases comprise implied consent. For example, if a person meets an accident and falls unconscious, In this case, although the person can’t expressly grant consent for treatment, healthcare professionals can proceed to provide medical treatment to that person.
Situations when implied consent is typically applied:
How to balance patient autonomy and provider responsibilities for implied consent?
Expressed consent and informed consent are often used interchangeably, but they have distinct meanings and roles in the patient-provider relationship.
While informed consent is about informing patients about the possible risks and complexities in connection with something before they proceed with a proposed intervention, express consent refers to a specific method or form of obtaining consent.
Expressed consent involves agreeing to a proposed action through a written or verbal statement after a thorough comprehension of the information shared by the provider.
How can healthcare providers strike a balance between patient autonomy and the provider’s responsibilities for expressed consent?
The concept of consent in pediatric settings remains a complex issue, often confusing clinicians and researchers about which consent they should obtain in cases involving minors. Since children do not have the same moral weight as adults, they are considered incapable of making decisions on their own and, therefore, providing consent.
Regulations require both parental permission and obtaining assent from the potential child subject in this case. While parental permission protects the child from assuming unreasonable risks, assent demonstrates respect for the child and his developing autonomy.
Striking a balance between patient autonomy and provider’s responsibility for assent consent:
When obtaining informed consent from patients may be challenging or impossible, such cases account for emergency or surrogate consent.
In emergency situations, patients may be incapacitated, unconscious, or unable to communicate their wishes. Emergency consent in this case comes to the rescue for both patients and providers. It allows providers to presume consent and take immediate action to address the patient’s urgent medical requirements.
Providers should document the rationale for presumed consent, the circumstances of emergency consent, the medical condition of the patient, and the steps taken.
When a patient lacks the capacity to provide informed consent and delaying treatment poses a serious risk to the patient’s life, providers can engage surrogate decision-makers to make decisions on their behalf. The inability to make informed decisions could be due to the medical condition of the patient, language barriers, cognitive impairments, etc.
Surrogate decision-makers are appointed by patients themselves or designated by the law to make healthcare decisions in the best interests of patients. An authorized individual can be a family member, legal guardian, or healthcare power of attorney.
To strike a balance between patient autonomy and healthcare provider’s responsibilities:
In an evolving legal landscape where expectations of patients for respecting their rights are on the rise, careful comprehension and application of the consent process are a must.
Additionally, understanding the different types of consent is crucial to fostering trust with patients. Knowing where one applies and the pertinent strengths and flaws of each can help providers strike a balance between their responsibilities and patient autonomy.